Sm. .%i. Med. Vol. 35, No. I, pp. 3141,

Printed in Great

Britain.

1992

0277-9536/92

TOWARD

55.00 + 0.00

Copyright 0 1992 Pergamon Press Ltd

All rights reserved

A CULTURAL HISTORY PERSONALITY DISORDERS

OF THE

CHARLESW. NUCKOLLS Department of Anthropology,

Emory

University,

Atlanta,

GA 30322, U.S.A.

Abstract-Psychiatric categories in general, and the personality disorders in particular, remain problematic and contested. This is no where more clearly evident than in the case of the ‘antisocial’ and ‘histrionic’ personality disorders. In part, the problem is related to the observation of differences in gender distribution. Men arc more likely to be diagnosed ‘antisocial’ than women, and women are more likely to be diagnosed ‘histrionic’ than men. Confusion results partly from the suspicion that these categories may be culturally conditioned and therefore spurious as medical labels true in some ‘absolute’ sense. This paper argues that the antisocial and histrionic disorders have cultural histories, representing (in extreme form) values strongly congruent with familiar cultural stereotypes: the ‘independent’ male and the ‘dependent’ female. The process by which these values were delegated to men and women is examined, and then shown to be at least partly determinative of later developments in the formation of psychiatric categories. Kqv words-psychiatric

classification,

antisocial

and histrionic

Psychology can never tell the truth about madness because it is madness that holds the truth about psychology. Michel Foucault, Mental Illness and Psychology,

p,

personality

disorders,

cultural

history

troubling suspicion that some psychiatric categories may be culturally conditioned and therefore spurious as medical labels true in some ‘absolute’ sense. A second observation troubling to many in the psychiatric profession is that the antisocial and histrionic personalities are identified partly in relation to their ability to beguile and deceive. Psychiatrists warn of this and of the need to be vigilant against “liking the patient too much.” Antisocials are often men who appear, at least at first, both intelligent and strong. Histrionics are often women who appear, again at first, attractive and seductive [3, p. 1391. Yet psychiatric practice tells us that these may be false images, and indeed, as diagnostic criteria, the very things which help to define some personalities as pathological. In this paper I argue that the antisocial and histrionic personality disorders have cultural histories. They represent in extreme form values and attitudes strongly congruent with familiar cultural stereotypes: The ‘independent’ male and the ‘dependent’ female. The cultural histories of these stereotypes can be traced to an ‘ideal self,’ a construct very close to the ‘ideal type’ described by the sociologist Max Weber in his analysis of Western capitalism [7]. That idea of ‘self’ combined religious morahsm and worldly materialism, creating by the beginning of the eighteenth century the unique synergy Weber identified as the capitalist exemplar or ‘ideal type.’ ‘Moralism’ refers to a constellation of values centered on faith in God and in one’s own ‘election’ to spiritual salvation. ‘Materialism’ refers to a belief that materially successful work in a God-given ‘calling’ is indicative of spiritual election. Combined, these values created a personality strongly predisposed to hard

73, 1987.

INTRODUCTION The diagnostic categories of modern psychiatry remain controversial in the extreme, but nowhere more so than in the case of the so-called ‘personality disorders’ [I]. Some psychiatrists refuse to acknowledge them, or do so only grudgingly, with what amounts to resignation [2]. Other psychiatrists proclaim that the personality disorders are the developmental precursors of the clinical (Axis I) syndromes, and so deserve the greatest attention [3]. Between these two extremes is the vast majority, who unite in their hope that someday, out of the current muddle, reliable criteria and treatment programs will emerge. This paper seeks to enter the muddle where it is the most clouded, in the expectation that where confusion is profound-where doubts about naming and knowing are the most keenly felt-there the interaction between cultural and psychiatric models will be the most visible. I will focus on two personality disorders, the ‘antisocial’ and the ‘histrionic,’ because here the confusion can be related to the observation that there is a correlation between gender and disorder. Men are 5-10 times more likely to be antisocial than women [4] and women are 8 times more likely to be histrionic than men [5,6]. As the author of one recent review put it, “this has led some to question whether the traits under consideration reflect abnormality in some absolute sense or only cultural bias” [S, p. 2901. Confusion results partly from the 37

38

CHARLES

W.

work, professionalism, investment, and deferred gratification-the very qualities Weber believed were necessary to the formation of western-style capitalism. Experientially, however, materialism and moralism became increasingly difficult to sustain in balanced combination. Weber himself noted this and concluded that by the end of the nineteenth century materialism had won out. Yet there is another interpretation. From very early, contradictions between moral and materialist values were keenly felt and consciously reflected on. As such contradictions increased, they were partially resolved through a strategy similar to the psychological mechanism of ‘splitting’ [8]. Conflicting features, like ‘moralism’ and ‘materialism,’ were retained (because both continued to be valued), but separated and projected outward onto delegate groups. The groups then ‘acted out’ the qualities that were assigned to them. In the case of the capitalist ‘ideal self.’ men became delegates for that part of the self identified with matertalism. Women became delegates for that part of the ‘ideal self’ identified with moralism. Distinctive strategies emerged characteristic of each delegate group’s attempt to maximize these values and fulfil its role expectations. I argue below that the behaviors of antisocial men and histrionic women follow logically from these strategies. PERSONALITY

DISORDERS

Antisocial and histrionic persons actively use social relationships to achieve sought-after states of dependency. The antisocial struggles against dependency and treats other people either as obstacles, to be removed, or as tools, to be manipulated. His superficial charm is a trap. The histrionic, on the other hand struggles against a deep inner loneliness to achieve dependency on others. But because the histrionic allure is fleeting-and founded. ultimately, on an ‘internal agenda’ which has nothing to do with making and maintaining real external relationshipsthe charm fades as the promise of a deeper interaction proves misleading. Cases illustrative of the antisocial and histrionic personality disorders are examined below. The protot)lpir

antisocial personulit!,

The association of antisocial personality with criminal behavior goes back at least as far as Lombroso’s articulation of a category type he called ‘the born criminal’ [9] and continues to this day. to the dismay of several theorists who advocate a less biased approach [IO]. DSM-III-R, however. preserves this historic association in listing typical ‘criminal’ behaviors as archetypal traits of the antisocial personality. These include lying, stealing, vandalism, initiating fights, and physical cruelty. Case Studies in Psychiarr)’ for the House OJicer conforms to the same approach in its presentation of the following vignette,

NUCKOLLS

‘Sad or Bad,’ which the authors illustrative of the category:

identify

as most

Jerry, a 35-year-old white male, is brought to the emergency room by the police. He is an inmate at the nearby state prison and 20 min before had been cut down from the bars of his cell after he had tried to hang himself. Although initially delirious secondary to anoxia suffered during his suicide attempt, he rapidly became lucid and gave the following history. He had spent, on and off, a total of I3 years in prison for innumerable burglaries and several armed robberies and had 6 more years left in his current sentence. He didn’t like prison and occasionally became badly depressed for days or weeks at a time as he contemplated his situation. Today, for reasons he didn’t understand, things looked particularly black He had tried to change his mood with some ‘downers’ illicitly obtained from another prisoner but they were of no help. In a fit of hopelessness. he rolled his shirt, wrapped it around a bar. and jumped from a book placed on end. He then only remembers struggling to free himself unsuccessfully. His record describes a 9th grade education and criminal activity since his early teens. Most of his arrests have been for thefts of one kind or another. There is little history of assaults or violent behavior. Apparently he has also used a variety of drugs over the years, although there is no suggestion of addiction to a single substance. The diagnosis seen repeatedly in his prison record is antisocial personality disorder. After he has recovered from his delirium, he chats freely and openly. He is honest about his past, seems chagrined at his illegal behavior, convincingly describes serious depressive feelings, and wishes his life-had turned out otherwise. He is warm, friendly, humorous, and thoroughly likeable. The house officer silently questions the propriety of ‘labeling’ such an engaging human being with antisocial personality disorder and is mildly upset as the police brusquely usher the prisoner from the emergency room after his physical status has stabilized [4. p. 1221.

house officer’s reluctance to recognize antisocial traits is characteristic of the antisocial person’s ability to deceive. Cleckley. whose early work [I I] contributed to the current definition of the syndrome, defined this ability in terms of three traits: (1) superficial charm and good intelligence; (2) absence of ‘nervousness’ or psychoneurotic manifestations; and (3) absence of delusions and other signs of irrational thinking [l I, pp. 338-3391. But what makes these traits pathological is their configuration within a personality whose goal is not to make and maintain social relations toward which, as a rule, the antisocial person is indifferent or hostile. The antisocial instead struggles to achieve mastery and control by manipulating other people. When this cannot be done by ‘playing the game’ and acting through legitimate means, he becomes belligerent and offensive, and uses force to achieve his objectives. The

The prototypic

histrionic personalit)

Like the antisocial, the prototypic histrionic personality has features which correspond to a stereotype long recognized by health professionals: the exhibitionistic and emotional patient, usually female. who demands attention; whose emotions are labile; and whose temperament and behavior are fickle. Among the adjectives typically used to describe the

Toward a cultural history of the personality disorders histrionic are these: dependent, infantile, seductive, tempestuous, self-centred, and over-emotional. Most case studies concentrate on the histrionic’s behavioral presentation and, as in studies of the antisocial, explicitly warn clinicians against their own susceptibility. This case, entitled ‘Coquette,’ from Case Studies in Psychiatry .for the House Ojicer,

is a good

example: A thirty-year-old cocktail waitress sought treatment after breaking up her relationship with her 50-year-old boyfriend, although initially she was tearful and suicidal, she brightened up within the first session and became animated and coquettish with the male interviewer. During the intake interviews she was always attractively and seductively dressed, wore carefully applied facial makeup, and crossed her legs in a revealing fashion. She related her story with dramatic inflections and seemed very concerned with the impression she was making on the interviewer. Although she often cried during sessions, her grief appeared to be without depth and mainly for effect. Several times she asked that the next appointment be changed to accommodate her plans; and when this was not possible, she became furious and talked of how ‘doctors have no concern for their patients.’ The patient’s history reveals that she is frequently the life of the party and has no problem making friends, although she seems to lose them just as easily and feels lonely most of the time. People apparently accuse her of being selfish, immature, and unreliable. She is often late for appointments; borrows money, which she rarely returns; and breaks dates on impulse or if someone more attractive turns up. She is competitive with and jealous of other women, believes that they are catty and untrustworthy, and is known for being particularly seductive with her friend’s boyfriends [4, p. 2651.

The histrionic uses behavioral ploys to achieve a state of dependency and so, even though her style is ‘active,’ like the antisocial’s, her goal is very much the opposite. She wants approval and attempts to win it through superficial charm and adaptability. She learns to be alert to signs of rejection and avoids disapproval “by paying close attention to the signals others transmit, adapting all behaviors to conform with their desires” [12]. COMPARING HISTRIONIC

AND PERSONALITIES

ANTISOCIAL

Toward a cultural history of the ‘idea self’

Weber traced the development of modern western capitalism to the early seventeenth century, when affinities between ideology of work and religion created a special ethos. The exemplar of this ethossomething Weber called an ‘ideal type’-was a person who depends on the will of God for his salvation, and although that fate (one way or the other) is preordained, he must act in the world as though salvation were certain. Constructive action enhances the feeling of certainty when it produces tangible results and this, it was held, happens when the individual works in an occupation to which he has been ‘called.’ The ‘calling’ constrains occupational choices by making decisions dependent on God. Simultaneously, it frees occupational endeavors from ‘traditionalistic’ limits (e.g. family, caste, etc.) by defining success and failure

individualistically, As Weber notes,

39

in terms of the personal struggle.

it had the psychological effect of freeing the acquisition of goods from the inhibitions of traditionalistic ethics. It broke the bonds of the impulse of acquisition in that it not only legalized it, but looked upon it as directly willed by

God [7, p. 1711. In Western capitalist society, the ideal type was therefore highly dependent (vis-a-vis God) and highly independent (uis-a-vis the world) both at the same time. Among the most noteworthy manifestations of this type, Weber thought, was the American founding-father, Benjamin Franklin. The differing dependency relationships definitive of the Weberian ideal type set up special emotional perspectives. These differed, however, depending on which they focused on, God or the world. Toward God the individual should behave with utmost piety, demonstrating his devotion to the reality God represents. Toward the world the individual should behave in a detached and distanced manner, demonstrating success in his calling and transcendence of the world of material things. Yet the individual knows that he must be wary. The external world lays traps which, ironically, increase in number and intensity the more successful he is: hence, Weber notes, the Puritan distrust and avoidance of sensual pleasures with no religious significance or which distracted the participants from fruitful work. “It is naturally no accident that the development of a manner of living consistent with that idea may be observed earliest and most clearly among the most consistent representatives of this whole attitude toward life. Over against the glitter and ostentation of feudal magnificence which . . prefers a sordid elegance to a sober simplicity, they set the clean and solid comfort of the middle-class home as an ideal” [7, p. 1711. The middle-class home, with its careful comfort and avoidance of ostentation, therefore acted as a kind of ‘containment’ device, restraining acquisitive impulses from becoming ends in themselves and directing them always to higher and more spiritual accomplishments. Dependence and independence are definitive of the capitalist ideal type as Weber described it. Yet they are increasingly contradictory at the level of experience, making adherence to either one difficult within the terms set by the Protestant ethic. Worldly success attests to fulfilment in the calling and election by God. Thus, the more successful he is, the closer the individual should feel to his salvation. Yet the opposite, as Weber notes, is more likely to happen. A preoccupation with material things increases with increasing success in a worldly calling. God recedes as satisfaction in obtaining tangible rewards encourages and reinforces the individual’s independent stance toward the world. The triumph of this stance culminates in the cult of the individual and in the elevation of personal ‘effort’ and ‘will’ to ethical principles higher than grace and salvation. At this point the

40

CHARLES W. NUCKOLLS

‘individual’ becomes the source of his own salvation. ‘Materialism’ is the means and measurement of his success. Materialism’s ascendency-assured, Weber beaurocracy capitalism thought, by the secular creates-no longer requires dependency on God as its supporting ideology. The cult of the individual is ideology enough. In fact, materialism now looks with suspicion at anything which threatens to re-assert the individual’s dependency on mechanisms he cannot control. Weber saw this as falsely liberating, and condemned the modern period for its loss of the spiritual ethos that the Protestant ethic had supplied: No one knows who will live in this cage in the future. or whether at the end of this tremendous development entirely new prophets will arise, or there will be a great rebirth of old ideas and ideals, or, if neither, mechanized petrification. embellished with a sort of convulsive self-importance. For of the last stage of this cultural development, it might well be said: ‘Specialists without spirit. sensualists without heart; this nullity imagines itself that it has attained a level of civilization never before achieved’ [7. p. 1821.

But do people become the ‘sensualists without spirit’ Weber described, and does ‘moralism,’ once vital to the ideal self construction, no longer exist? Weber. it is clear, spoke only for men, and for those men who. by the end of the nineteenth century, dominated the world of business. Because they no longer practiced worldly asceticism, he assumed no one did, and therefore that the values he identified with Calvinism were extinct. However, moralism was not extinct. It had simply been allocated to women who, throughout the Victorian period, were increasingly seen as the preservers and enforces of religious morality and of the spiritual life [ 13, 141. Women became ‘domestic nuns’ whose purpose was to keep the religious flame alive and burning in the specially protected realm of the ‘home’ [IS]. As Michelet, a mid-nineteenth century author, wrote: the wife is one “who, in the wretched days, when the heavens are dark, and everything is disenchanted, will bring God to (her husband), making him find and feel Him on her bosom” [16]. Rhetoric of this kind is common during this period and knew no bounds, as writers increasingly sought to link divine and feminine natures, even to the point of identifying Christ as essentially feminine. Said one mid-nineteenth clergyman of ‘woman’: “She must open the long disused page of the beatitudes among us, for manly energy rots among its husks, having dismissed reproving meekness and poverty of spirit. Let woman offer them an asylum; let her rise and take the beautiful shape of the Redeemer” [17]. The spiritual and moral world thus remains intact, though increasingly distant from the material world. It is confined, for the most part, to special people (married women) special places (the church and the home) and to special times (Sundays and religious holidays). If materialism and moralism were no longer parts of the same dynamic synergy, but now exist

separately and in opposition to each other, what happened? A psychological analogy might help. Instead of the ‘capitalist,’ let us say that we are talking about any human being, and instead of ‘dependence and independence,’ let us say that we are talking about any two demand systems which conflict at the level of experience. Several strategies exist to provide the struggling ego with the means to accommodate conflicting demands. One, ‘splitting,’ refers to the ego’s ability to separate demands by assigning them to physically distinct and external entities. The assigned entities then act out the conflicting demands, opposing each other and sometimes ‘fighting it out,’ but never to the point that one side really wins over the other. The purpose is to retain conflicting values by rendering their contradictory demands external to the self and by insuring that those who represent these demands (as delegates) have more or less equal strength As a psychological construct the Weberian ideal type represents an unstable configuration of competing values which the ego cannot sustain in the absence of highly structuring ideology. Perhaps orthodox Calvinism supplied that ideology at one time, during the period when the capitalist ‘ideal self’ was being forged. Yet many people, it is clear, found moralism and materialism more and more difficult to compromise. A settlement had to be reached, to both preserve and protect competing values. The cultural ‘solution’ was to split the ideal self and to assign its conflicting values-moralism and materialismalong gender lines: moralism to women, materialism to men The process leading up to this ‘splitting’ can be traced. Internal contradictions are apparent from the very point in history where the capitalist personality becomes discernible. Even then-as early as the midseventeenth century-people consciously recognized internal contradictions and commented on them, wondering what could be done to reduce their conflict.

John

Wesley,

co-founder

of Methodism,

wrote:

For religion must necessarily produce both industry and frugality, and these cannot but produce riches. But as riches increase, so will pride. anger, and love of the world in all its branches. How then is it possible that Methodism, that is, a religion of the heart, though it flourishes now as a green bay tree, should continue in this state? For the Methodists in every place grow diligent and frugal; consequently they increase in goods. Hence they proportionately increase in pride, in anger, in the desire of the flesh, the desire of the eyes, and the pride of life. So, although the form of religion remains, the spirit is swiftly vanishing away. Is there no way to prevent this-this continual decay of pure religion? We ought not to prevent people from being diligent and frugal; we must exhort all Christians to gain all they can, and to save all they can; that is, in effect to grow rich [18].

The ‘ideal typical’ personality created during this period drew its energy from an admixture of attributes that always threatened to destabilize itselfthat is, to tip the balance between moralism and

Toward a cultural history of the personality disorders materialism in favor of one or the other, and thus become religiously ethereal, with no practical interest in the world, or brutishly worldly, without the religiously-inspired capacity to delay gratification. But even in Wesley’s lamentation, we see the route that would be taken toward resolution of this contradiction. The clue is in the phrase ‘religion of the heart,’ rich in its allusion to the human body and in its potential for metaphorization. The body is a powerful locus of symbolic extension. It can be viewed holistically, as an integrated and interdependent entity, or as a collection of organs and parts, each with its own distinctive characteristics and functions. Social attributes and functions can be ‘mapped onto’ the body and the body used as a way to understand how society works. The Hindu vision of society and its four uarna-s (‘castes’) as physical divisions of a primordial man called Prajapati is one example. Comte’s physiological approach to sociological description is another. In constructing a metaphor in the language of the body, Wesley showed how a resolution of the contradiction between moralism and materialism could be achieved. Religion, and all things moral and spiritual, could become affairs of the ‘heart.’ Business, and all things material and worldly, could be (and in fact, were) located elsewhere: in the head, in the hands, in the whole external surface of the body. Seeing things this way permitted contradictory values to exist separately, fulfilling different functions, and at the same time together, contributing to the maintenance and wellbeing of the whole. Emphasizing one or the otherthe ‘whole’ or the ‘parts’-is a matter of choice, to be decided on according to the biases and desires of the decider. The deployment of body images, and the delegation of competing values to body parts, prefigures the allocation of competing values along gender lines. The fact that moralism was located internally, in the ‘heart,’ made the allocation of moralism to women correlative with the development of women’s complaints that were defined as internal and emotional, and centered (not coincidentally) on ailments located in the stomach and bowels [19-211. The cultural etiology of these conditions as they configure psychiatric categories is discussed later. Two more general historical questions must first be posed: How do we recognize-and how do we measure-transformations in gender identity that mark the ‘allocation’ of moralism and materialism to women and men? And, what are such transformations correlated with? Representations in popular art make for a useful and very accessible ‘gauge’ by which to measure transformations in male and female gender constructions. In the seventeenth century, for example, men and women were represented more as equals materially and spiritually. Bram Dijkstra writing on the work of the Dutch painter, Frans Hals, notes:

41

Frans Hals’ man and woman-married or not-are friends. It is evident that they tease each other argue, have opinions are companions. They are equals-and that fact does not bother them a bit [15, p. 91. ‘Moralism’ and ‘materialism,’ as recognizably discrete orientations, do not seem to have existed. Not coincidentally, men and women change in their artistic representations as moralism and materialism become distinct. Women become more ethereal and men become more worldly. But by the middle of the 18th century this is evident. Now, as Dijkstra points by children, out, we find “. . . women surrounded women looking admiringly at their husbands, women who have become pale creatures with curved necks and weak knees” [15, p. 91. The change corresponds to the process by which women and men adopted the role attributes assigned them as delegates for the split off and projected aspects of the ideal self. Something in the years between, say, 1600 and 1800, created and then powerfully reinforced the division, making it seem so ‘natural’ that by the end of that period explanations of masculine and feminine characteristics were sought solely in biological inheritance. Few historians have failed to note this massive shift. In writing on American culture during this period, Glenna Mathews notes: The co!onial home, then was both essential and mundane, mundane because it had no transcendent functions. What is more, nothing in the culture reflected glory on the woman in charge of the home. By 1850 all of this had changed. The nome was so much at the center of the culture that historians speak of a ‘cult’ of domesticity in the early to mid-nineteenth century. Women in their homes were the locus of moral authority in society [14]. The most obvious candidate as a mechanism for working this change is, of course, the ‘industrial revolution’ or more specifically, the division of labor which industrialization both created and depended on. Even as late as 1800, the position of women was vastly different from what it was to become 50 years later. Horace Bushnell, the famous nineteenthcentury New England clergyman, looked back from that later time and commented, bemusedly, on the domestic way of life that had been lost to industrialization: “[They were] harnessed, all together, in to the producing process, young and old, male and female, from the boy that rode the plough-horse to the grandmother knitting under her spectacles. . . The house was a factory on the farm; the farm a grower and producer for the house” [22]. As to women, Bushnell remembered his own mother this way: She was providing and training her six children, clothing her whole family in linens and woollens, spun, every thread, and made up in the house also to a great extent by herself. She had a farm-and-dairy charge to administer, also the farm workmen to board, and for five or six months in a year the workers, beside, of a homespun cloth-dressing shop. All this routine she kept moving in exact order and time, steady and clear as the astronomic year.. What mortal endurance could bear such a stress of burden! And yet she scarcely showed a look of damage [23].

42

CHARLES W. NUCKOLLS

Bushnell’s frank amazement in recalling his mother stands in stark contrast to his assessment of his wife: “[hers] is not an ambitious noisy power, it is silent, calm, persuasive, and often so deep as to have its hold deeper than consciousness itself. She ministers and yet is seldom ministered unto” [23, p. 1I I]. In the generation which separated Bushnell’s mother and wife, a vastly reconceptualized vision of the woman’s role had come into being. Whereas the older woman (Bushnell’s mother) had been an essential worker and producer and administrator in the domestic economy of the household, the younger woman’s (Bushnell’s wife) principal role was to provide uplifting moral encouragement, not direction or advice: She was to ‘minister,’ not to ‘administer.’ The irony was that as she lost her role as a producing co-equal, she gained-or was seen to gain-the role of spiritual guide and moral guardian, ‘influencing’ if not actually directing her family members to the attainment of higher ends. Many historians trace changes in women’s identity to the changes in the mode of production, from farm to factory and from country to city [I 3. 151. Such changes moved the social center of gravity, as it were, away from the domestic sphere in which women participated as co-producers to the city and the factory, where men dominated. The ‘elevation’ of women, and of the home, to their position as moral bastions can be traced to their decline, in due proportion, as units of production. But there was probably more to it than that. The re-definition of the household, and the re-valuation of women, began earlier, even before the first industrial inroads were made. and so belie the claim that changes in production were exclusively responsible. In fact, the process seems to have been well under way as early as the sixteenth century-two hundred years before Adam Smith described the first momentous changes taking place under the development of the factory model. Before the middle of the sixteenth century, the ‘family’ as we know it hardly existed. Instead, there were extended networks of kinship and clientage which linked people together by bonds later historians would call ‘feudal’ [24]. Marriage, as the rite which constitutes the nuclear family of a later age, was not all that common. The bond between husband and wife-so vital in later concepts of the ‘companionate’ family-was significant mainly as a token of solidarity between groups, and could be replaced or superseded as relationships between groups changed. But the period between 1560 and 1640 saw a massive shift, as feudal orders collapsed and were replaced by ‘states,’ which viewed the survival of extended kin networks as an indirect threat to the state’s claim to prior loyalty. “Fueled initially by a general desire for security,” writes the historian Lawrence Stone, “the expansion of the bureaucratic nation state soon took on an independent life of its own” [24]. Even the Church, which had once played a vital role in such

networks, was diminished as state organizations placed limitations on the clergy, reducing and in some cases wholly eliminating the power and privileges of clerical office. The state gradually assumed more and more of the authority and responsibility that all these organizations possessed, resulting eventually in the reduction of the extended network to its nuclear family core. As kinship through extended networks declined, the conjugal family rose in importance, eventually replacing the medieval Catholic concept of monkish chastity as an ideal for all members of society. Marriage now became a sacred act and holy institution: a far cry from the medieval view that the socially sanctioned union of men and women was necessary only to keep unruly human passions under control. Sacralization of the marriage state and of the conjugal family gave rise to hyperbolic adulation, presaging the worshipful tone adopted by Victorian writers. By the first half of the seventeenth century, contemporary writers were calling it “an early paradise of happiness” and “a thing pure as light, sacred as a temple, lasting as the world” [24, p. 1341. The creation of ‘holy matrimony’ and the construction of domesticity as a sacred realm were thus largely complete more than a century before industrialization drew men and women apart into their separate spheres. After the mid-eighteenth century. when industrialization and the formation of a capital economy began in earnest, a perspective which attached spiritual qualities to the conjugal home and materialist qualities to the world was already in place. With the demise of the household as the principle unit of production and the rise of the factory, men and women separated: men went outside. to the factories, and thus into the material world that Christian thinking ever since the Middle Ages had viewed with suspicion. Women, meanwhile, were left at home, in the recently re-valued domain of domestic sanctity. which they now presided over. Increasingly, the separation was viewed as a natural one, with a woman’s confinement to the home now seen as a natural consequence of her constitution: she was sacred and pure and so was the home and thus it was inevitable that she should be in the home. The same was true for men. Their removal to the world of ‘work’ was the natural consequence of their worldliness. Capitalist economy did not create these divisions, but it did exploit them and reinforce them. A CASE STUDY: MAX WEBER AND HIS FAMILY

The cultural division of labor and the allocation of values between genders had consequences for personality development that can best be grasped in the lived experience of real individuals. Potential sources abound in the diaries and personal memoirs of the period, as several recent histories which use these materials attest [13,25, 141. But it seems only fitting

Toward

a cultural

history

that, for an analysis that is already dependent on his social history for its theoretic development, we should turn to Max Weber’s personal history for illustrations. Max Weber’s family represents a typical working out of the process whereby an internal conflict is projected onto the external world and delegate groups-those who chose or are chosen to act out competing value orientations-assume the responsibility and the risk. The father, Max Sr, represented or was made to represent (it doesn’t matter which for our purposes) a person who wanted power and possessions as ends in themselves, as instruments of comfort and ease, and not as manifestations of spiritual attainment. He thus served as a ‘delegate’ for the ideal self’s split-off and projected ‘worldly’ half. According to Marianne. the younger Weber’s wife: Max’s father was totally honorable, utterly unselfish in politics and in his job, intelligent, good-humored, warmhearted, and amiable so long as things went his way, but a typical bourgeois, at peace with himself and with the world. He categorically refused to recognize the serious problems of life. In his mature years he loved inner comfort, closed

his eyes to suffering, and did not share the sorrows of others P61. The mother represented a person whose task in life was to exemplify an uncompromising religious morality and devotion to the inner life, uncontingent on practical necessity. In her, the powers of the gospel were active, to whom loving service and self-sacrifice to the last were second nature, but who also lived in accordance with burdensome heroic principles, performed her inordinate daily tasks with a constant expenditure of moral energy, never ‘left well enough alone,’ and quietly placed every significant event in the context of eternity. She was dynamic in all she did, energetic in coping with her everyday chores, joyously open to everything beautiful in life, and had a liberating laugh. But every day she plunged into the depths and was anchored in the supernatural [26, pp. 62-631. For

her,

little

else counted

beyond

the

certainty

in

could be obtained through adherence to ascetic practices and the religious life-style. She thus served as a delegate for the ideal self’s split-off and projected ‘spiritual’ half. Weber’s wife and biographer, Marianne Weber, consciously reflected on this contrast in considering her husband’s childhood and adolescence: “In those years it was not clear whether [he] would decide in favor of his father’s or his mother’s type. He already had an obscure feeling that such a choice would have to made someday-as soon as he got hold. of himself and consciously began to develop his own personality” [26, p. 621. But the decision was not an immediate one, and in the meantime, Weber successfully integrated moral and materialistic, maternal and paternal images. He became, for a while, the embodiment of the capitalist ideal self. His mother’s intransigent moralism established the value of unremitting labor and of the ascetic way of life. His father provided a divine

grace

of the personality

disorders

43

focus-governmental policies and national politicswhere Weber could work to effect practical change. Scholarship was the link. He used it to bring moral idealism (represented by his mother) to bear on the troubled world of late nineteenth century German politics (represented by his father.) The synergy created by this internal integration was highly productive-Weber was a prolific and successful young scholar-and was highly unstable, since it depended on keeping both sides together and intact. That delicate balance collapsed when Weber suffered a mental breakdown following an argument with his father and his father’s death soon afterward. Significantly, the argument took place just after Weber finally established his own household, independent of father’s support. His mother wanted to visit and, as was her custom, wished to travel alone and unaccompanied by her husband. This Weber Sr refused to allow, since it challenged his authority as paterfamilias (and also since, one suspects, made him feel secondary to his son in relation to his wife). When the two arrived in Heidelberg, the junior Weber’s new home, there was a terrifying confrontation between the son and the father: Then the long-threatening disaster came to a head. The son was no longer able to contain his pent-up anger. The lava had erupted and the monstrous thing happened: a son sat in judgment on his father. The settling of accounts took place in the presence of the women. No one tried to restrain him. He had the clearest conscience and felt better during this row, which marked the end of his previous diplomatic treatment of all family difficulties. His mother’s freedom was at stake, she was the weaker one, and no one could violate

her spiritual rights, ‘We demand that Mama should have the right to visit us alone quietly for four to five weeks each year at a time that is convenient for her. As long as this is not done, any family relationship with Papa is meaningless to us and its outward maintenance has no value for us’ [26, pp. 230-23 I].

Apparently the father left immediately, and seven weeks later-with no other communication with his son-he died.

that

Weber returned to his teaching duties but found them increasingly burdensome. Soon he was a wreck, with symptoms of what might now be called ‘major depression,’ As his wife relates: a fountain of youth after each busy . sleep-normally day-would not come and functional disturbances began to appear. Weber again felt ill. He was extremely exhausted, his solid frame was weakened, and tears welled up. Weber felt himself at a turning point. Nature, so long violated, was beginning to take revenge. The doctor did not consider it a serious matter and ordered hydrotherapy. This only increased his excitement and banished sleep completely [26, p. 2351. condition persisted, off and on, for 5 years. Eventually Weber had to abandon regular teaching and most of his scholarly activities, even to the point of requesting dismissal from his position as professor at the University of Heidelberg. His scholarly work This

44

CHARLES

W.

did not commence again until he began writing The Protestant Ethic and the Spirit qf Capitalism. Writing on someone’s mental breakdown some 90 years after it took place is risky, to say the least, but from the abundant material in his wife’s memoir, a tentative interpretation can be proposed. Marianne’s account stresses that Weber’s father and mother were opposed in basic matters of temperament and outlook: Helene. the mother, was ‘spiritual’ and strove relentlessly to perfect her own and her family’s moral worth. Max Sr, the father, was ‘worldly’ and endeavored to create the most comfortable physical circumstances for his own and his family’s well-being. The two conflicted, openly and continually, for years, as both attempted to make their son choose between them and all they represented. Until the terrible show-down in Heidelberg. however, it appears that Weber never made a choice-on the contrary, his extraordinary productivity up to that point might have depended on not definitively accepting or rejecting either of the two extreme positions his parents represented. Weber’s strong defense of his mother, however, and his rejection of his father, precipitated a crisis which in effect constituted the choice that had been put off for so long. He defeated his father. But worse still was the victory he achieved on behalf of the values represented by his mother: moralism had vanquished materialism. and with such total success that the opposing side not only retreated but dissolved. The guilt was overwhelming and, judging from Weber’s ‘choice’ of symptoms (inertia. avoidance of work. and the constant need for comfort and support), compensated for by a punitive transformation into the very thing he had defeated: an inert and comfort-seeking man with no ability and no desire to struggle for ‘higher’ goals. This only made the situation worse. for as Mitzman, Weber’s later biographer, comments: “The result of this secretion of his father’s spirit in his own ego was. the pitiless mutilation of this ego by a superego that still incarnated his mother’s standards of discipline and independence” [26. p. 2351. Weber’s breakdown was coincident with the breaking apart of a character structure that had been based, at least partly, on the ‘therapeutic alliance’ of opposed maternal and paternal legacies. The five years that followed were occupied in putting together a different structure that was not so volatile and tenuous. Clues to the nature of this new character structure can be found in Weber’s first great scholarly achievement after the worst of his depression abated, in 190405: The Protestant Ethic and the Spirit of Capitalism. In it Weber traced the affinities between an other-worldly religious spirit and a practical orientation to work in the world, to account for the special synergy that powered Western capitalism. It is a sociological treatise with profoundly psychological roots, since it depends on accepting this proposition: that to avoid feeling lonely, and to achieve certainty of spiritual salvation, individuals devoted themselves

NUCKOLLS

to work in a calling. It is very likely that in interpreting the history of western capitalism, Weber was also interpreting himself-recognizing in its development and in his own the special synergy created when material work combines with religious calling. With this recognition, Weber seems to have liberated himself from the consequences of siding too drastically with one side or the other. His intense depression lifted. It was replaced, however, by an almost cynical resignation. In the last pages of The Protestant Ethic, this resignation is clear: “For of the last stage of this cultural development, it might well be truly said: ‘Specialists without spirit, sensualists without heart; this nullity imagines that it has attained a level of civilization never before achieved” [7, p. 1821. It is hard to escape the conclusion that Weber may have viewed this as his own fate at that time. THE

DEVELOPMENT

OF

ABNORMAL

PERSONALITIES

The dicine ,female consumptice Weber’s mother represented the values which had been delegated to her. She was not unique, of course. Many women performed the same function. Their job, as domestic nuns, was to represent the moral and spiritual side of the capitalist ideal self which Weber abstracted, using Calvinist dogma as an archetype. Those who came closest to the ‘ideal’ adopted a pattern greatly admired in art at the time, in magazine lithographs and illustrations everywhere: the image of the slightly ethereal female who hung delicately between this world and the next. As a being unconnected with the practical world outside, she could approach the divine and thereby convey to her worldly male counterparts and family members the important values of faith, morality, and truth. Various methods existed to fulfil this image. Through confinement at home and immersion in domestic affairs, women kept themselves pure and unsullied by the world outside. Through regular attendance at church, women maintained the link to God. But the method which most emphatically linked women to the spiritual world was illness. Getting sick demonstrated how close women were to God by threatening to remove them from the world and return them to the realm to which they belonged. Images of weak and sickly women were praised as manifestations of the divine. This is nowhere more clearly evident than in the late nineteenth century apotheosis of the consumptive women, whose image decorates popular periodicals of the day. Hollow-cheeked and drawn, such women recline on beds but seem to be held down to them only by the most tenuous of links, as if at any moment they might give up their bodies and float to the spiritual realm. Typically, a male doctor stands by, trying to help, but in a position that suggests that he is trying to persuade the sick woman to stay on earth and among the living. (Frank Dicksee’s ‘The

Toward a cultural history of the personality disorders Crisis,’ drawn in 1891, is a good example) [15]. Such images ‘meant’ something. Women imitated sick styles by wearing clothing and cosmetics which enhanced thinness, suggested pallor, and created the appearance of a certain ‘lightness of being.’ Nothing was more aesthetically discordant than the image of a truly robust female, strong and healthy, and fully involved in activities outside the sacred home. Most women did not go to the extreme of making themselves ill in order to more adequately fulfil the role of moral spirits. But, given the high value and ready acceptance of that role, many women did use illness complaints to achieve that end. Validation as a woman in a highly valued role meant taking on the role of spiritual moralist-and illness, as an expression of spiritual release became a legitimate means for its realization. The histrionic personality disorder The beautiful invalids of late nineteenth century illustrations suggest a cultural etiology for the disorder we now term ‘histrionic.’ The beauty these women project depends on their other-worldliness, a state they achieve either accidentally or deliberately through wasting bodily conditions. Illness and beauty were not incompatible with each other, but were seen together as co-determiners of the feminine ideal. Ordinary women simply took the hint. Getting sick and going to the doctor validated a self-image and provided a means for projecting that image outward, into a milieu which had elevated the feminine sick role to an archetype of feminine perfection. The prototypic histrionic is a woman who expects to be seen as beautiful in the role of sick person. She makes her claim by accentuating her illness behavior and coercing the attention. All of this is in unconscious recognition of the fact that the sick role for women is culturally sanctioned by the view which holds that women most closely approach the sacred when their bodies fail. But she also acts provocatively (like a ‘coquette’) and puts at risk the image of frail dependence her illness helps her create. What makes the histrionic woman’s behavior necessarily anomalous is this: she confuses expressive and instrumental functions, making illness a means to an end rather than a manifestation of an end already achieved. Criminals, businessmen and drunks Weber’s father, like his mother, represented the values which had been delegated to him. These values centered on ‘materialism’ and expressed themselves generally in capitalist economy, the process whereby goods are presented to ‘consumers,’ who choose among ‘commodities’ and make their selections. But since capitalist commodities are numerous, they must compete for consumers’ attention. They do so, as Haug [28] points out, by creating and responding to new consumer needs through advertising. ‘Advertising’-viewed in the abstract-is the ability to manip-

45

ulate consumer acceptance through presentational and stylistic alterations. The goal is acceptance (here of a commodity) not necessarily because of the product’s greater value or superior inner quality, but because of its ability to alter itself to conform to any taste. People become cautious consumers whose motto, ‘caveat emptor,’ helps to prevent them from being led astray by attractive commodities. This is an important expression of ‘materialism.’ It is a hardened, even cynical attitude toward buyable things-an attitude which tries to reduce the ‘noise’ commodities create with their advertising to a simple and straightforward message of utility: will the product do for me what I want it and need it to do? The answer to the question is supposed to be personal-ountervailing influences are described as ‘infringements’ on the individual consumer’s ‘right’ to choose. The key word here is ‘individualistic.’ It is the principle defining feature of consumer attitude and attribution, and thus the basis for the cynical distance people are enjoined to take. Men, as delegates of ‘materialism,’ bear the chief responsibility for acting this out. They must strive simultaneously to maximize others’ susceptibility (so that they can sell them things) and to minimize their own (so that they can avoid being ‘taken in.‘) The methods used to achieve conformity vary, but always include the willingness to use force in persuasion (threats to buy something ‘before time runs out’ is an example) and the willingness (even compulsion) to stay somewhat removed from the fray. The antisocial personality disorder The prototypic antisocial person whose behavior does not invoke criminal sanctions is powerfully equipped to function in the world of consumer capitalism. He is a shrewd judge of character and uses his knowledge to carefully exploit others. It is usually a long time, too, before his victims know what has happened to them. The ‘trick,’ as it were, is advertising, since it works by convincing would-be consumers that they both want and need what’s offered. The antisocial ‘advertises’ himself, by appealing to observer’s needs and convincing them that it is in their own best interest to do what he says. The antisocial’s greatest fear, however, is that he may be led astray by the very people he intends to dupe. He therefore adopts attitudes and mannerisms that lower the risk, becoming cold and withdrawn toward some, haughty and domineering toward others. One case referred to among the clinicians I work with has to do with a business executive who was highly praised by his superiors for his gumption and drive: he was the sort who could ‘sell water to a drowning man.’ His staff workers, however, lived in terror because of the same man’s impersonal and imperious style. Perhaps most men like this do not come to the attention of clinicians, but in this case the subject entered therapy because his wife, who had

CHARLES W. NUCKOLLS

46

seen both sides of his personality and liked neither, insisted. He complied, although he stated at the very beginning that therapy was useless trickery and worked only for gullible fools. The antisocial as a cultural construct presents in extreme form the two values most highly ‘selected for’ in Western capitalist societies. He uses self-advertising to sell himself to a susceptible public. Once the sale is complete, he drops the charming facade and reveals an inner coolness, which keeps him at a distance and prevents others from approaching closely. But the prototypic antisocial is a criminal who puts these traits to use in occupations society defines as illegal. Does that mean that most antisocials are criminals? Smith [29] argues that this is unlikely and suggests that highly placed antisocials simply do not enter the criminal justice system as often as their humbler counterparts in the rest of society. The poor man who robs gas stations and the rich man who robs pension funds may be equally ‘antisocial,’ but the law more easily takes account for the former than the latter. Indeed, wealthy and successful men with strongly antisocial characteristics may more often be upheld as models. Criminality is not the prototypic antisocial’s sole defining feature, however. Diagnostic manuals, like DSM, invariably mention the high correlation between drinking and antisocial behavior. Possibly alcoholism is a method antisocials adopt to create or enhance the behavior described as ‘deviant.’ Thus, as a health effect, excessive drinking would correspond to the histrionic’s use of bodily symptoms to conform to an image of female beauty. Clinically diagnosed ‘antisocials’ are those who have taken too literally society’s message that drinking is an expression of independence and self-sufficiency. They see drinking not just an expression of independence but as a means to independence as a masculine role feature. The histrionic too, confuses expressive and instrumental functions. She uses illness as the antisocial uses alcohol, not to manifest but to create the state of dependency society defines as true and legitimate for women. CONCLUSION

This paper began as an attempt to interpret the disproportionate representation of men and women among those diagnosed with the personality disorders known as ‘antisocial’ and ‘histrionic.’ Following Weber’s articulation of a capitalist ‘ideal type,’ the existence of a historically constituted ‘ideal self’ was proposed. That ideal ‘self’ consisted of elements that were seen as increasingly contradictory at the level of experience. Eventually they became distinguishable as ‘materialism’ and ‘moralism.’ Both were retained, because both continued to be valued, but through their allocation to people of different ‘types’ the conflict between them was displaced to the conflict between types. ‘Splitting’ is the process by

means of which this was achieved. It refers to the separation of contradictory features and their projection them onto delegate groups, who then ‘act out’ these features using certain well-marked behaviors. Women became delegates for values associated with ‘moralism’ and men became delegates for values associated with ‘materialism.’ Particular behavioral styles emerged that were seen as characteristic: women were ‘prone’ to spirituality, illness and hysterical display just as men were prone to worldliness, aggression, and shrewd calculation. The behaviors of women and men diagnosed, respectively, as ‘histrionics’ and ‘antisocials’ follow logically from these styles. “Diagnosis,” as Lock notes, “is a social process, a creation of patient and physician together” [30]. It is also, quite clearly, an historical process shaped by changing notions of who we are and where we come from. Such notions are not always consistent with each other, as Alexis de Tocqueville, who visited the United States in the 1830s pointed out early on. This is most clearly evident in the values of independence and dependence. The question is, what happens to values and attitudes that are greatly cherished but that, because of forces arising historically, become increasingly contradictory in subjective experience? Stein, in a study of Soviet-American relations, has already proposed an answer that is political. International competition between the superpowers is sustained as each side projects onto the other disavowed characteristics of its own identity [3l]. Americans project ‘repudiated collectivist dependency wishes’ onto the Soviets who then, as delegates, ‘act out’ such wishes and thus permit Americans ‘act out’ the reverse fantasy of independence. A similar argument, but framed in terms of different values, was put forward years ago by Bateson to describe Israeli-Palestinian relations [31]. I have proposed that we view gender identities and their realization in psychiatric terms as part of the same process. But, like Stein, I do not claim that the process of conflict, ambivalence, and splittingunderstood here as group and not individual phenomena--‘accounts for’ either gender identity or psychiatric classification by themselves. But they do contribute to the formation of such things in ways we are only now beginning to recognize. Foucault said something similar: Our society does not wish to recognize itself in the ill individual whom it rejects or locks up; as it diagnoses the illness, it excludes the patient. The analyses of our psychologists and sociologists are, therefore, above all a projection of cultural themes. In fact, a society expresses itself positively in the mental illnesses manifested by its members; and this is so whatever status it gives to these morbid forms: whether it places them at the center of its religious life or whether it seeks to expatriate them by placing them outside social life [32].

One important outcome is an approach to social problems not as problems but as solutions to problems

Toward a cultural history of the personality disorders which are somehow concealed. Thus, for examole. the

‘problem’ of Soviet-American relations would be seen, in part, as a ‘solution’ to a problem which arises internally, through ambivalence over the issue of control, and is resolved externally, through the playing out of superpower politics [33]. And in the same way, the ‘problem’ of the personality disorders and their classification would be seen (again, only in part) as a ‘solution’ to the contradictory valuation of independence and dependence and their allocation along gender lines. Acknowledgements-This research was supported by a fellowships from the National Institute of Mental Health, the American Council of Learned Societies, the National Endowment for the Humanities, and by a grant from the National Science Foundation. Gratitude is expressed to Howard Stein, for his advice and example, and to Hugh Freeman, Tom Johnson, Atwood Gaines, Walter Goldschmidt. John Kennedy, Janis Nuckolls, Kath Weston, and Tom Weisner for their comments. The usual disclaimers apply.

41

12. Millon T. and Everly G. Personality and Its Disorders: A Biosocial Learning Approach. Wilev. New York. 1985. 13, Douglas A. The Femtnization of -American Culture. Anchor, New York, 1977. 14. Mathews G. “Jus: a Housewife:” The Rise and Fall of Domesticity in America. Oxford University Press, New York, 1987. 15. Dijkstra B. Idols of Perversity. Oxford University Press, New York, 1986. 16. Michelet J. Women (La Femme) (Translated J. Palmer), p. 80. Carleton, New York, 1860; quoted in Dijkstra B. Idols of Perversity, p. 12. Oxford University Press, New York, 1986. 17. D. Wise In Christian Examiner, Vol. 56, pp. 33-34, 1854; quoted in Douglas A. The Feminization of American Culture, p. I lO.Anchor, New York, 1977. 18. Southey A. Life of Wesley, 2nd edn, p. 308; quoted in Weber M. The Protestant Ethic and the Spirit of Capitalism, p. 175. Scribners, New York, 1958. 19. Brumbera J. Chlorotic eirls. 1870-1920: a historical perspectiie on female adolescence. Child Dec. 53, 1468-1477, 1982. 20. Figlio K. Chlorosis and chronic disease in 19th~century Britain: the social constitution of somatic illness in a capitalist society, Int. .I. Hlth Services 8, 589-617, 1978. 21. Strouse J. Alice James: A Biography. Houghton Mifflin. Boston, 1980. 22. Bushnell H. The age of homespun. Litchfield County Centennial Celebration, p. 114. Hartford, 1851; quoted in Douglas A. The Feminization of American Culture, p. 52. Anchor, New York, 1977. 23. Cheney M. Li$e and Letters of Horace Bushnell, p. 27; quoted in Douglas A. The Feminization of American Culture, p. 53. Anchor, New York, 1977. 24. Stone L. The Family, Sex and Marriage in England, 1500-1800. Harper and Row, New York, 1977. 25. Gay P. The Education of the Senses: From Victoria IO Freud. Oxford University Press, New York, 1984. 26. Weber M. Max Weber: A Biography, p. 63. Transaction Books, New Brunswick, 1988. 27. Mitzman A. The Iron Cage: An Historical Interpretation of MUX Weber, p. 159. Transaction Books, New Brunswick, 1985. 28. Haug W. Critique of Commodity Aesthetics. University of Minnesota Press, Minneapolis, 1986. 29. Smith R. The Psychopath in Society. Academic Press, New York, 1978. 30. Lock M. DSM-III as a culture-bound construct: commentary on culture-bound syndromes and international disease classifications. Culture, Med. Psychiut. 11, -1,

REFERENCES 1. Tischler G. (Ed.) Diagnosis and Classification in Psychiatry: A Critical Appraisal of DSM-III. Cambridge

University Press, Cambridge, 1987. 2. Ludwig A. Principles of Clinical Psychiatry, 2nd edn, pp. 303-304. Free Press, New York, 1986. 3. Millon T. Modern Psychopathology: A Biosocial Approach IOMaladaptive Learning and Functioning, p. 3. Saunders, Philadelphia, 1969. 4. Tomb D. and Christensen D. Case Studies in Psychiafry. Williams & Wilkins, Baltimore, 1987. 5. Cooper A. Histrionic, narcissistic, and compulsive personality disorders. In Diagnosis and ClassiJcation in Psychiatry (Edited by Tischler G). 6. Koenigsberg H., Kaplan R., Gilmore M. ef al. The relationship between syndrome and personality disorder in DSM-II experience with 1995 patients. Am. J. Psychiat. 142, 207.-212, 1985.

I. Weber M. The Protestant Ethic and the Spirit of Capitalism. Scribners, New York, 1958. 8. Fenichel 0. Collective Papers of Otto Fenichel, Vol. 2. Norton, New York, 1954. 9. Lombroso C. Crime, Its Causes and Remedies (Translated by H. Horton). Little, Brown, Boston, 1911. IO. Millon T. Disorders of Personality, DSM-III: Axis II. Wiley, New York, 1981. Il. Cleckley H. The Mask of Sanity, 5th edn. Mosby, St Louis, [I9411 1976.

35-42,

_

1987.

31. Bateson G. Steps to an Ecology of Mind. Chandler, San Francisco, 1972. 32. Foucault M. Mental Illness and Psychology, Universitv I. of California Press, Berkeley, 1987. 33. Stein H. The indispensable enemy and American-Soviet relations. Ethos 17, 480-503, 1989.